Healthcare Provider Details

I. General information

NPI: 1063519726
Provider Name (Legal Business Name): JARED VAN DER BEEK P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BUSH ST LOWR LEVEL
SAN FRANCISCO CA
94109-5239
US

IV. Provider business mailing address

1A WAINWRIGHT PL
MILL VALLEY CA
94941-5034
US

V. Phone/Fax

Practice location:
  • Phone: 415-763-5523
  • Fax:
Mailing address:
  • Phone: 415-763-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA009772
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016150
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13995
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number33779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: